title: [Chylous ascites as a serious complication of the neuroendocrine tumor of ileum -  case report].
abstract: BACKGROUND
  Chylous ascites is a rare complication of the gastrointestinal neuroendocrine tumor. There are two mechanisms of its origin: mechanical obstruction by the tumor mass and fibrosis of the surrounding tissue due to overproduction of serotonin. Its presence restricts treatment options.
  
  
  METHODS
  We report a case of 66year old man suffering from recurrent diarrhoea and ascites. We found elevated tumor marker Chromogranin A and elevation of hydroxyindoleacetic acid (5- HIAA) in the urine. A subsequent whole body scintigraphy scan by octreoscan confirmed multinodal process with increased somatostatin receptors activity in the wall of the ileum, rectosigmoideum, lymph nodes of the retroperitoneum and mesenterium and left supraclavicular area. We performed bio-psy from the lymph node of supraclavicular area, and there was metastasis of the neuroendocrine tumor. Start of cytostatic therapy was repeatedly complicated by recurrent massive chylous ascites. The patient underwent only one series of palliative chemotherapy. Another procedure was again complicated by chylous ascites that caused hospitalization at the internal department, and the patient died four months after dia-gnosis.
  
  
  CONCLUSIONS
  Chylous ascites is a very rare complication of gastrointestinal neuroendocrine tumor. It is not only a marker of poor prognosis, but also a complication that makes systemic treatment very difficult.
authors.forename: V M
authors.initials: VM
authors.lastname: Matějka
authors.forename: O
authors.initials: O
authors.lastname: Fiala
authors.forename: R
authors.initials: R
authors.lastname: Tupý
authors.forename: L
authors.initials: L
authors.lastname: Holubec
authors.forename: J
authors.initials: J
authors.lastname: Fínek
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor; D002915:Chylous Ascites / Q000175:diagnosis / Q000209:etiology*; D017809:Fatal Outcome; D006801:Humans; D007078:Ileal Neoplasms / Q000150:complications* / Q000175:diagnosis; D008297:Male; D018358:Neuroendocrine Tumors / Q000150:complications* / Q000175:diagnosis; D010166:Palliative Care
chemical_list: D014408:Biomarkers, Tumor
keywords: case report - neuroendocrine tumors - chylous ascites - malignant carcinoid syndrome